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Monitoring of nutritional status in children with inflammatory bowel disease

Monitoring of nutritional status in children with inflammatory bowel disease
Measurement At diagnosis Every 4 to 6 months Growth failure
Weight (plot on growth chart to track percentile) X X X
Height (plot on growth chart to track percentile and/or calculate height velocity) X X X
BMI (calculate from weight and height and plot on growth chart to track percentile)* X X X
Pubertal status X X X
Biological parents' height X    
24-hour diet recall or 3- to 5-day diet record If concerns   X
Nutritional supplement intakeΔ X   X
Anticipatory guidance for diet and feeding behavior X   X
Laboratory testing for micronutrient deficiencies X   X
Bone age◊     X
Bone densitometry (DXA)§ If practical   X
This chart depicts the authors' approach to monitoring nutritional issues in children with inflammatory bowel disease and is consistent with expert panels[1]. We generally define growth failure as a persistent decline in height percentiles or height velocity less than 10th percentile for age.
BMI: body mass index; DXA: dual-energy x-ray absorptiometry; SD: standard deviation.
* In children 2 to 18 years.
¶ Pubertal staging is suggested at least annually in girls starting at age 9 years and boys starting at age 10 years.
Δ A review of vitamins, minerals, oral or enteral formulas, herbal/botanical or other complimentary and alternative medicine produces.
◊ Determination of bone age requires expert interpretation by a radiologist or endocrinologist with experience in the technique.
§ Bone densitometry is strongly recommended in patients with growth failure, secondary or primary amenorrhea, pubertal delay, severe course of inflammatory bowel disease, or prolonged use of glucocorticoids. If the bone mineral density Z-score is more than 1 SD below the mean, the scan should be repeated every 1 to 2 years[2]. Bone densitometry is also suggested for older children and adolescents at the time of diagnosis with inflammatory bowel disease, if this test is practical and available. The optimal age for starting monitoring is not defined.
References:
  1. Rufo PA, Denson LA, Sylvester FA, et al. Health supervision in the management of children and adolescents with IBD: NASPGHAN recommendations. J Pediatr Gastroenterol Nutr 2012; 55:93.
  2. ​Pappa H, Thayu M, Sylvester F, et al. Skeletal health of children and adolescents with inflammatory bowel disease. J Pediatr Gastroenterol Nutr 2011; 53:11.
Courtesy of Jonathan Teitelbaum, MD, and Paul Rufo, MD, MMSc.
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